三维超声评估感染性心内膜炎栓塞事件及住院死亡的危险特征

目的 采用三维经食管超声心动图评估感染性心内膜炎栓塞及住院死亡的超声特征。方法 回顾性收集124例自体瓣膜感染性心内膜炎患者,分析其经胸二维超声、多平面和三维经食管超声特征。将手术前或后1个月内栓塞和死亡作为主要终点事件。将大赘生物、脓肿或瘘、腱索断裂、中重度瓣膜反流和瓣膜穿孔或严重瓣膜破坏各计1分,进行简单积分,对心脏受损累计简单积分、赘生物大小、瓣膜受损严重并失去正常形态结构采用Hosmer和ROC曲线下面积评估栓塞和不良事件。结果 124例患者中,27例（27/124,21.77%）患者发生栓塞。与二维经胸超声心动图比较,多平面和三维经食管超声心动图可识别赘生物的确切位置及其长度,而二维经胸超声心动图漏诊左心房和乳头肌赘生物。栓塞及不良事件患者血红蛋白显著低于非栓塞及不良事件患者（P<0.05）。栓塞及不良事件患者多部位赘生物形成、赘生物活动度和瓣膜严重受损并失去正常形态构成比均高于非栓塞及不良事件患者（P均<0.05）。感染性心内膜炎心脏受损累计简单积分、赘生物大小、瓣膜严重受损并失去正常形态结构曲线下面积分别为0.65（P=0.06）、0.60（P=0.19）、0.70（P=0.03）。结论 多平面及三维经食管超声对感染性心内膜炎,尤其位于不常见位置的赘生物诊断起重要作用。瓣膜严重受损并失去正常形态者与栓塞及不良事件有关。     

经胸超声诊断感染性心内膜炎瓣膜赘生物形成

目的探讨感染性心内膜炎心脏瓣膜赘生物的超声声像图特点及诊断价值。方法应用经胸超声心动图观察心脏瓣膜赘生物的形态、大小、回声、分布及其瓣膜损害情况,对28例感染性心内膜炎心脏瓣膜赘生物进行超声诊断。结果超声心动图对赘生物的大小、位置及数量的判断与手术所见基本一致,同时还能对心脏有无原发病变及继发新血流动力学改变进行探查和判断。结论经胸超声心动图对感染性心内膜炎赘生物形成的诊断、定位、治疗决策及预后判断有重要的临床意义。     

超声诊断艾滋病患者感染性心内膜炎

目的 探讨艾滋病(AIDS)合并感染性心内膜炎患者彩色多普勒超声心动图特征。 方法 观察227例AIDS合并感染性心内膜炎患者彩色多普勒超声心动图,结合临床资料和实验室检查结果进行回顾性分析。 结果 227例患者心脏各瓣膜、室壁、房室间隔内膜面均有不同程度增厚、毛糙和赘生物形成,以右心心内膜炎最常见。病原微生物种类以细菌、真菌感染为主,可为混合性感染。通过内科抗感染治疗,赘生物84例(37.00％,84/227)消失,79例(34.80％,79/227)缩小,64例(28.19％,64/227)变化不大,但回声增强、活动度减少。 结论 AIDS合并感染性心内膜炎患者的超声心动图有特征性的改变,可为临床诊断、治疗提供有价值的信息。     

经胸超声心动图对起搏器相关感染性心内膜炎的诊断价值

目的探讨经胸超声心动图在起搏器相关感染性心内膜炎中的诊断价值。方法回顾分析经手术证实的21例起搏器相关感染性心内膜炎患者的超声心动图特点,并与血培养结果对照分析。结果 21例患者术中发现电极导线上存在赘生物者13例(61.9%),单纯心脏瓣膜存在赘生物者1例(4.8%),电极导线及心脏瓣膜均存在赘生物者7例(33.3%)。超声心动图显示赘生物14例,直径为5~40 mm,其附着部位、个数及大小与手术结果相符。超声诊断感染性心内膜炎阳性率达66.7%(14/21),漏诊7例(33.3%),其中6例提示起搏器导线不均匀增粗,1例为单纯三尖瓣赘生物,赘生物直径﹤5 mm。血培养阳性者10例,阳性率为47.6%(10/21)。结论对于直径﹥4 mm的心内赘生物,超声心动图诊断起搏器相关感染性心内膜炎有较高的诊断敏感性和准确性,可作为临床诊断的主要依据。     

经胸超声心动图在感染性心内膜炎诊断中的临床价值

目的探讨经胸超声心动图在感染性心内膜炎诊断中的临床价值。方法回顾性分析2003年9月-2013年9月已确诊的35例感染性心内膜炎患者的经胸超声心动图表现,常规行心脏各切面扫查,测量各腔室大小及心功能,观察心脏各室壁及瓣膜形态、活动、功能,诊断有无基础心脏疾病,重点了解心内有无赘生物及其分布、形态、大小、数目、回声、活动度等,并结合血培养结果综合分析。结果初次经胸超声心动图检查阳性29例,阴性6例,阴性者1周后复查,2例阳性,4例仍为阴性;赘生物分布:二尖瓣8例,主动脉瓣15例,三尖瓣5例,肺动脉瓣1例,肺动脉管壁1例,室间隔右心室面1例。合并有基础心脏疾病29例,其中先天性心脏病8例,后天性心脏病21例,无明显基础心脏疾病6例。血培养33例阳性,2例阴性。结论经胸超声心动图能快速、准确、早期诊断感染性心内膜炎,对赘生物能准确定位、大致定量,明确瓣膜是否受损及其程度,了解有无并发症,对于早期诊断、治疗、随访及判断预后均具有重要价值。     

超声心动图诊断小儿感染性心内膜炎的临床应用价值

目的探讨超声心动图在诊断小儿感染性心内膜炎中的临床应用价值。方法收集2005至2010年上海交通大学医学院附属新华医院收治的30例疑似感染性心内膜炎患者的临床资料,分析所有患者的经胸超声心动图表现,观察心脏瓣膜赘生物形态、大小、回声,分布及其瓣膜功能并与血培养以及血清学试验结果对照。结果初次经胸超声心动图检查发现阳性23例,阴性7例。其中真阳性22例,假阳性1例,真阴性4例,假阴性3例。经胸超声心动图发现赘生物：三尖瓣上7例,二尖瓣上2例,肺动脉瓣上3例,主动脉瓣上3例,肺动脉内3例,主动脉上赘生物合并瓣周脓肿形成2例,右心房内2例。1例瓣膜修补术后患者超声诊断为二尖瓣上赘生物,经多次反复检查证实为手术缝线。5例初次超声心动图检查阴性的患者1周后复查,3例发现赘生物;2例因疾病早期已使用抗生素治疗,所以未发现赘生物。超声心动图诊断感染性心内膜炎的敏感度为88.0%（22/25）,特异度为80.0%（4/5）。条索状、絮状及较大团块状赘生物活动度大,随心脏收缩、舒张来回摆动;小结节状赘生物活动度小或固定不动;钙化的赘生物回声较强,部分伴声影。27例血培养（+）,3例血培养（-）。致病菌主要为链球菌（10株）、葡萄球菌（10株）、假单胞菌（3株）、真菌（4株）。结论感染性心内膜炎的早期诊断对提高预后极其重要。由于微生物培养试验所需时间较长,超声心动图可早期诊断并可对赘生物进行定位,缩短诊断时间,对治疗的决策及预后判断均有重要意义。     

超声心动图诊断感染性心内膜炎赘生物的价值

目的探讨感染性心内膜炎赘生物的超声心动图特点及诊断价值。方法应用超声心动图观察心脏赘生物的形态、大小、回声、分布及其瓣膜损害情况,对30例感染性心内膜炎心脏赘生物进行诊断。结果赘生物主要附着主动脉瓣10例,其次是二尖瓣8例,同时累及主动脉瓣和二尖瓣5例,三尖瓣1例,肺动脉瓣2例,动脉导管未闭主肺动脉2例,室间隔缺损右室面2例。赘生物长径约3～27mm,呈低回声至强回声。超声心动图对心脏赘生物的位置、大小、形态及数量的判断与手术所见基本相符,超声心动图还能对心脏基础病变及继发心血管血流动力学改变进行诊断。结论超声心动图对感染性心内膜炎赘生物能进行准确定位,并能确定其大小、形态、数目及评估心脏情况,对治疗决策及预后判断有重要的意义。     

超声诊断二叶主动脉瓣合并感染性心内膜炎

目的 观察经胸超声心动图（TTE）和三维经食管超声心动图（3D-TEE）诊断二叶主动脉瓣（BAV）合并感染性心内膜炎（IE）的价值。方法 回顾性分析53例BAV合并IE患者的超声图像，超声表现包括赘生物、瓣膜穿孔、脓肿和瘘道。以外科手术所见作为金标准，评估TTE和3D-TEE的超声特征及其诊断价值。结果 3D-TEE检出赘生物、瓣膜穿孔、脓肿和瘘道的敏感度（100% vs.90.20%，96.87% vs.90.62%，92.86% vs.67.86%，94.12% vs.70.59%）和阳性预测值均高于TTE（100% vs.95.83%，100% vs.93.55%，96.30% vs.86.36%，100% vs.85.71%，P均<0.05）。结论 超声心动图对于BAV合并IE的总体检出率高。3D-TEE的可视性和空间分辨率比TTE更好，诊断BAV合并IE敏感度和阳性预测值更高。     

经胸超声心动图对感染性心内膜炎的诊断价值

目的探究经胸超声心动图对感染性心内膜炎的诊断价值。方法选取就诊的80例疑似感染性心内膜炎患者,均行经胸超声心动图检查、血培养检查。比较血培养检查和经胸超声心动图的阳性检出率,并观察赘生物的位置情况。结果 80例疑似感染性心内膜炎患者中,经胸超声心动图检出76例阳性,血培养检出68例阳性,经胸超声心动图阳性检出率(95.00%)高于血培养(85.00%),差异有统计学意义(χ2=4.444,P=0.035)。76例确诊的感染性内膜炎患者中,赘生物处于主动脉瓣占55.26%,二尖瓣前、后叶占26.32%,三尖瓣占14.47%,肺动脉瓣占3.95%。其中65例患者接受手术治疗,其赘生物所在部位、大小与经胸超声心动图诊断一致,准确率100.00%。结论经胸超声心动图对感染性心内膜炎的阳性检出率较高,可准确诊断赘生物的位置,为早期治疗提供重要依据。     

超声心动图误诊白塞病的临床分析

目的 分析超声心动图将白塞病误诊为主动脉瓣感染性心内膜炎患者的声像图特征及误诊原因。方法 回顾性分析我院临床诊断白塞病累及心血管系统患者资料,总结其临床及超声表现。结果 12例白塞病患者中,9例为心脏术前患者,3例为心脏术后患者。9例心脏术前患者均表现为重度主动脉瓣反流,其中3例合并主动脉瓣周脓肿、4例合并主动脉瓣赘生物形成、2例合并主动脉瓣周脓肿及赘生物形成;3例心脏术后患者表现为主动脉瓣人工瓣瓣周漏,其中1例主动脉瓣人工瓣赘生物形成、1例瓣周脓肿、1例人工瓣瓣周脓肿及赘生物形成。结论 伴有赘生物、瓣周脓肿等声像图表现的白塞病合并主动脉瓣关闭不全单纯依靠超声诊断较为困难,如果患者合并口、眼、生殖器等特征性器官损害应提示心脏白塞病可能性。     

经胸超声心动图诊断机械瓣膜功能障碍

目的 观察经胸超声心动图诊断机械瓣膜功能障碍的价值。方法 回顾性分析60例接受二次手术治疗的机械瓣膜功能障碍患者，观察本次术前经胸超声心动图、手术、术后病理及随访资料，分析超声的诊断及评估效能。结果 超声心动图检查共于60例患者中检出67枚机械瓣膜功能障碍，包括二尖瓣23枚、主动脉瓣43枚及三尖瓣1枚；主要表现为瓣周漏、瓣膜狭窄及关闭不全、血栓、瓣环脱位、感染性心内膜炎(IE)及窦部夹层等。手术及病理结果显示，60例67枚机械瓣膜功能障碍分布与超声检查所见一致，表现为瓣周漏16枚、瓣周纤维组织增生50枚、血栓19枚、瓣环脱位5枚、IE 12枚、退行性变6枚。随访期间59例未见明显人工瓣膜功能障碍；1例于二次术后第9年出现瓣周漏，经手术封堵后情况良好。结论 经胸超声心动图对于诊断机械瓣膜功能障碍具有一定价值，有助于判断是否需要进行再次手术治疗。     

Early surgical intervention in culture-negative endocarditis of the aortic valve complicated by abscess in an infant: A case report

BACKGROUNDSurgical therapy of infective endocarditis (IE) involving aortic valves and mitral valves is widespread. However, there are few reports concerning patients with culture-negative endocarditis complicated by the appearance of comorbid valvular perforation and abscess. Therefore, real-time surveillance of changes in cardiac structure and function is critical for timely surgical management, especially in patients who do not respond to medical therapy.CASE SUMMARYHere, we report an atypical case in a 9-mo-old infant without congenital heart disease but with symptoms of intermittent fever and macular rashes. Physical examination, laboratory tests, and electrocardiograms suggested a diagnosis of IE, although the result of blood cultures was exactly negative. After treatment with antibiotic drugs, the patient got a transient recovery. On the 9^th day, we proceeded with continuous echocardiogram due to fever again and the results revealed aortic valve abscess with perforation, regurgitation, vegetation, and pericardial effusion. Intraoperative monitoring revealed aortic valve perforation, presence of apothegmatic cystic spaces below the left coronary cusp of the aortic valve, and severe aortic valve regurgitation. Aortic valve repair was performed by autologous pericardial patch plasty. The patient was discharged after 4 wk of treatment and no complications occurred after surgery.CONCLUSIONOur case demonstrated the necessity of serial echocardiography monitoring for possible adverse symptoms of IE in pediatric patients.     

超声心动图诊断主动脉瓣四瓣化畸形

目的 观察超声心动图诊断主动脉瓣四瓣化畸形(QAV)的价值.方法 纳入63例QAV患者,将其分为轻度主动脉瓣反流(AR)组(n=20)、中度AR组(n=35)及重度AR组(n=8);回顾性分析超声声像图及临床资料,观察临床因素及瓣膜超声征象对于QAV的诊断效能.结果 经胸超声心动图(TTE)和/或经食管超声心动图(TE...     

Embolization of a huge tricuspid valve bacterial vegetation.

A case of a woman who had tricuspid valve bacterial endocarditis is presented. Her course was complicated by persistent disseminated intravascular coagulation and acute renal failure, followed by pulmonary embolization of the vegetation. Transthoracic echocardiography showed almost complete obstruction of the right pulmonary artery. The case demonstrates the impressive size to which right-sided infective vegetations can progress and the relative paucity of symptoms and hemodynamic derangements with which they may be associated, even in the context of potentially life-threatening complications.     

Infective bicuspid aortic valve endocarditis causing acute severe regurgitation and heart failure: A case report

BACKGROUNDInfective endocarditis (IE) is an uncommon but potentially life-threatening infection, which occasionally develops into acute severe valve insufficiency leading to the onset of heart failure, and necessitates timely intervention. However, the variable and atypical clinical manifestations always make the early detection of IE difficult and challenging.CASE SUMMARYA 45-year-old female who was previously healthy presented with exertional shortness of breath and paroxysmal nocturnal dyspnea. She also suffered from a significant decrease in exercise capacity, whereas her body temperature was normal. She had severe hypoxemia and hypotension along with a marked aortic valve murmur. Diffuse pulmonary edema and bilateral pleural effusion were observed on both chest X-ray and computed tomography scan. Transthoracic echocardiography was performed immediately and revealed severe regurgitation of the bicuspid aortic valve. Transesophageal echocardiography was further performed and vegetations were detected. In addition to adequate medical therapy and ventilation support, the patient underwent urgent and successful aortic valve replacement. Her symptoms were significantly relieved and the postoperative chest X-ray showed that pulmonary edema was significantly reduced. Histopathology of the resected valve and positive microorganism culture of the surgical specimen provided evidence of definite IE.CONCLUSIONIE should be considered in critical patients with refractory heart failure caused by severe bicuspid aortic valve regurgitation.     

Results of observation of infective endocarditis patients during 1965-2005

AIM: To clarify the trends in infective endocarditis by our experience for 40 years. MATERIAL AND METHODS: During the last 40 years (1965-2005) we observed 620 patients with infective endocarditis (IE). There were 615 patients with subacute IE (99.2%) and only 5 patients with acute IE (0.8%). There were 402 males (66.8%) and 218 females (35.2%). The age was 16-84 years (mean age 53 +/- 17). We studied the finding of hemoculture, echocardiography, immunological investigations, the levels of C-reactive protein. RESULTS: Streptococcal endocarditis runs a standard course, but more often we encountered staphylococcal, enterococcal endocarditis with a severe course. Predisposing cardiac disorders in 264 IE patients were rheumatic heart disease, congenital heart disease, mitral prolapse, involutive valve disease, hypertrophic cardiomyopathy, prosthetic valve. CONCLUSION: Conventional and unconventional IE cases, recurrent IE, current criteria of IE are described.